Sublabial rhinoseptoplastic technique for transsphenoidal pituitary surgery by a hinged-septum method

1980 ◽  
Vol 52 (6) ◽  
pp. 867-870 ◽  
Author(s):  
Takanori Fukushima ◽  
Keiji Sano
Keyword(s):  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Anterior Wall ◽  
Surgical Instruments ◽  
En Bloc ◽  
Content Type ◽  
Anterior Nasal Spine ◽  
Transsphenoidal Pituitary Surgery ◽  
Mucosal Perforation

✓ A new modification of the transseptal, transsphenoidal approach to the sella turcica is described. The procedure consists of unilateral dissection of the septal mucosa through a sublabial route, and retraction of the entire nasal septum with its upper attachment as a hinge. For mobilization of the septum, an L-shaped osteotomy is made along the base of the septum and along the anterior wall of the sphenoid sinus. It provides adequate exposure of the sphenoid sinus while preserving the septal structures. The anterior nasal spine and the edges of the nares are also left intact. The anterior wall of the sphenoid sinus is resected en bloc and is used as a bone splint for the reconstruction of the sellar floor. This approach has been performed in 45 cases of pituitary adenoma, one of craniopharyngioma, and one with sphenoid mucocele. There was no instance of complications such as mucosal perforation, septal deformity, or infection. Modifications of the surgical instruments used are described.

Modification of a nasal speculum for transsphenoidal surgery

2000 ◽  
Vol 92 (2) ◽  
pp. 359-360 ◽  
Author(s):  
Hiroji Miyake ◽  
Tomio Ohta
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Anterior Wall ◽  
Surgical Instruments ◽  
Content Type ◽  
Inferior Portion ◽  
Surgical Field ◽  
The Individual ◽  
Inferior Edge ◽  
Fine Print

✓ The authors modified a Hardy nasal speculum to improve the access to surgical fields and the handling of various instruments during transsphenoidal surgery. A section of the inferior edge of the speculum was cut out 2 cm from its orifice on both sides. The thickness of the tip of the speculum was also reduced. The authors are prepared to operate using a variety of speculum lengths (the distance between the tip and the cutting level), and this length is selected depending on the distance between the anterior wall of the sphenoid sinus and the surface of the gingiva in the individual patient.A modified nasal speculum was used in transsphenoidal surgery for a pituitary adenoma. With use of this device, the protrusion of the speculum above the gingiva was markedly decreased. Because most instruments are inserted into the inferior portion of the speculum orifice, this approach facilitated the handling of all surgical instruments through the modified nasal speculum. The actual surgical field became shallow and wide, and the long surgical instruments that are generally used for transsphenoidal surgery were unnecessary in most cases.

Sphenoid Sinus Mucocele Caused by Complications After Transsphenoidal Pituitary Surgery

2018 ◽  
Vol 29 (7) ◽  
pp. 1859-1861 ◽  
Author(s):  
Dong Hoon Lee ◽  
Woo Youl Jang ◽  
Tae Mi Yoon ◽  
Joon Kyoo Lee ◽  
Shin Jung ◽  
...  
Keyword(s):  
Sphenoid Sinus ◽  
Pituitary Surgery ◽  
Transsphenoidal Pituitary Surgery

A new bipolar right-angled coagulation forceps for pituitary surgery

1983 ◽  
Vol 58 (4) ◽  
pp. 614-615 ◽  
Author(s):  
Alex M. Landolt
Keyword(s):  
Pituitary Surgery ◽  
Bipolar Coagulation ◽  
Content Type ◽  
Anterior Aspect ◽  
New Instrument ◽  
Transsphenoidal Pituitary Surgery ◽  
Fine Print

✓ A new instrument is described which allows easy and precise bipolar coagulation of the anterior intercavernous sinus. In some cases this sinus covers the anterior aspect of the pituitary and may render transsphenoidal pituitary surgery difficult.

Thickening of sphenoid sinus mucosa during the acute stage of pituitary apoplexy

2001 ◽  
Vol 95 (5) ◽  
pp. 897-901 ◽  
Author(s):  
Kazunori Arita ◽  
Kaoru Kurisu ◽  
Atushi Tominaga ◽  
Kazuhiko Sugiyama ◽  
Fusao Ikawa ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Acute Stage ◽  
Mr Images ◽  
Content Type ◽  
Subepithelial Layer ◽  
Sinus Mucosa ◽  
Fine Print

✓ The authors treated two patients with pituitary apoplexy in whom magnetic resonance (MR) images were obtained before and after the episode. Two days after the apoplectic episodes, MR imaging demonstrated marked thickening of the mucosa of the sphenoid sinus that was absent in the previous studies. The relevance of this change in the sphenoid sinus was investigated. Retrospective evaluations were performed using MR images obtained in 14 consecutive patients with classic pituitary apoplexy characterized by acute onset of severe headache. The mucosa of the sphenoid sinus had thickened predominantly in the compartment just beneath the sella turcica, in nine of 11 patients, as ascertained on MR images obtained within 7 days after the onset of apoplectic symptoms. This condition improved spontaneously in all four patients who did not undergo transsphenoidal surgery. The sphenoid sinus mucosa appeared to be normal on MR images obtained from three patients at the chronic stage (> 3 months after onset). The incidence of sphenoid sinus mucosal thickening during the acute stage was significantly higher in the patients with apoplexy than that in the 100 patients without apoplexy. A histological study conducted in four patients who underwent transsphenoidal surgery during the early stage showed that the subepithelial layer of the sphenoid sinus mucous membrane was obviously swollen. The sphenoid sinus mucosa thickens during the acute stage of pituitary apoplexy. This thickening neither indicates infectious sinusitis nor rules out the choice of the transsphenoidal route for surgery.

Pathophysiology of hyponatremia after transsphenoidal pituitary surgery

1997 ◽  
Vol 87 (4) ◽  
pp. 499-507 ◽  
Author(s):  
Beatriz R. Olson ◽  
Julie Gumowski ◽  
Domenica Rubino ◽  
Edward H. Oldfield
Keyword(s):  
Water Balance ◽  
Fluid Intake ◽  
Sodium Intake ◽  
Pituitary Surgery ◽  
Dietary Sodium ◽  
Plasma Sodium ◽  
Water Load ◽  
Content Type ◽  
Transsphenoidal Pituitary Surgery ◽  
Fine Print

✓ Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery were studied. To evaluate posterior pituitary damage, a questionnaire was completed immediately after surgery in 61 patients. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after surgery. Patients were categorized on the basis of postoperative plasma sodium patterns. After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 ± 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients after water-load testing. Only one-third of the normonatremic patients excreted the water load and suppressed AVP normally. Hyponatremic patients were more natriuretic, had lower dietary sodium intake, and had similar fluid intake and cortisol and atrial natriuretic peptide (ANP) levels compared with normonatremic patients. Normonatremia, hyponatremia, and diabetes insipidus were associated with increasing degrees of surgical manipulation of the posterior lobe and pituitary stalk during surgery. The pathophysiology of hyponatremia after transsphenoidal surgery is complex. It is initiated by pituitary damage that produces AVP secretion and dysfunctional osmoregulation in most surgically treated patients. Additional events that act together to promote the clinical expression of hyponatremia include nonatrial natriuretic peptide—related excess natriuresis, inappropriately normal fluid intake and thirst, as well as low dietary sodium intake. Patients should be monitored closely for plasma sodium, plentiful dietary sodium replacement, mild fluid restriction, and attention to symptoms of hyponatremia during the first 2 weeks after transsphenoidal surgery.

Transnasal Endoscopic Approach to the Sella Turcica

1998 ◽  
Vol 12 (4) ◽  
pp. 283-288 ◽  
Author(s):  
Michelle R. Aust ◽  
Thomas V. McCaffrey ◽  
John Atkinson
Keyword(s):  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Sphenoid Sinus ◽  
Sella Turcica ◽  
Cerebrospinal Fluid Leak ◽  
Pituitary Surgery ◽  
Endoscopic Approach ◽  
Transseptal Approach ◽  
Transnasal Endoscopic Approach ◽  
Posterior Septum

The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidity and provides direct midline access to the sella and pituitary gland. Recent advancements in endoscopic surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopic route. Prior reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopic transnasal pituitary surgery from our institution. We report seven cases of transnasal endoscopic pituitary surgery. Our technique consists of endoscopic exposure of the sphenoid ostium unilaterally, excision of the posterior septum anterior to the rostrum of the sphenoid sinus with resection of the sphenoid rostrum for bilateral exposure of the sphenoid sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinates, permitting direct midline exposure of the sphenoid sinus and sella. We have progressively modified the technique over the seven cases that we present and will discuss our specific instrumentation, indications, and technique for this procedure. We have encountered one cerebrospinal fluid leak in this series. Patient satisfaction has been high and hospitalization is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopic approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.

Microsurgical anatomy of the sellar region

1975 ◽  
Vol 43 (3) ◽  
pp. 288-298 ◽  
Author(s):  
Wade H. Renn ◽  
Albert L. Rhoton
Keyword(s):  
Sphenoid Sinus ◽  
Carotid Arteries ◽  
Sella Turcica ◽  
Acute Angle ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
Optic Nerves ◽  
Content Type ◽  
Sellar Floor ◽  
Fine Print

✓ Fifty adult sellae and surrounding structures were examined under magnification with special attention given to anatomical variants important to the transfrontal and transsphenoidal surgical approaches. The discovered variants considered disadvantageous to the transsphenoidal approach were as follows: 1) large anterior intercavernous sinuses extending anterior to the gland just posterior to the anterior sellar wall in 10%; 2) a thin diaphragm in 62%, or a diaphragm with a large opening in 56%; 3) carotid arteries exposed in the sphenoid sinus with no bone over them in 4%; 4) carotid arteries that approach within 4 mm of midline within the sella in 10%; 5) optic canals with bone defects exposing the optic nerves in the sphenoid sinus in 4%; 6) a thick sellar floor in 18%; 7) sphenoid sinuses with no major septum in 28% or a sinus with the major septum well off midline in 47%; and 8) a presellar type of sphenoid sinus with no obvious bulge of the sellar floor into the sphenoid sinus in 20%. Variants considered disadvantageous to the transfrontal approach were found as follows: 1) a prefixed chiasm in 10% and a normal chiasm with 2 mm or less between the chiasm and tuberculum sellae in 14%; 2) an acute angle between the optic nerves as they entered the chiasm in 25%; 3) a prominent tuberculum sella protruding above a line connecting the optic nerves as they entered the optic canals in 44%; and 4) carotid arteries approaching within 4 mm of midline within or above the sella turcica in 12%.

Echoencephalographic A-scan study of the aqueduct and brain stem

1975 ◽  
Vol 42 (5) ◽  
pp. 508-512 ◽  
Author(s):  
Karl Guldberg Krogness
Keyword(s):  
Brain Stem ◽  
Sella Turcica ◽  
Normal Subjects ◽  
Anterior Wall ◽  
Diagnostic Aid ◽  
Content Type ◽  
The Brain ◽  
Posterior Position ◽  
Anterior Posterior

✓ The author utilizes autopsy models and normal clinical subjects with and without pneumoencephalography to demonstrate the value of echoencephalography in delineating the position of the aqueduct of Sylvius. Echoes from the dorsum sellae, the anterior wall of the sella turcica, and the aqueduct proved consistently identifiable, while echoencephalographic examination of 25 normal subjects revealed in all instances well-defined aqueduct echoes. Thus the aqueduct echo method may be a diagnostic aid in determination of the anterior-posterior position of the brain stem.

A novel transnasal transsphenoidal speculum: a design for both microscopic and endoscopic transsphenoidal pituitary surgery

2011 ◽  
Vol 114 (5) ◽  
pp. 1380-1385 ◽  
Author(s):  
Richard A. Chole ◽  
Chris Lim ◽  
Brian Dunham ◽  
Michael R. Chicoine ◽  
Ralph G. Dacey
Keyword(s):  
Transsphenoidal Surgery ◽  
Sella Turcica ◽  
Pituitary Surgery ◽  
Transsphenoidal Approach ◽  
Surgical Approaches ◽  
Surgical Experience ◽  
Endoscopic Techniques ◽  
Minimally Invasive Surgical ◽  
Transsphenoidal Pituitary Surgery ◽  
Microscopic Techniques

Over the last several years minimally invasive surgical approaches to the sella turcica and parasellar regions have undergone significant change. The transsphenoidal approach to this region has evolved from a sublabial transnasal, to transnasal, to pure endonasal approaches with the increasing popularity of endoscopic over microscopic techniques. Endoscopic and microscopic techniques individually or in combination have their own unique advantages, and the preference of one over the other awaits further technological refinements and surgical experience. In parallel with this evolution in techniques for transsphenoidal surgery, the authors designed an adaptable versatile speculum for the endonasal/transnasal transsphenoidal approach to the sella turcica and parasellar regions that can be used equally effectively with a microscope or an endoscope. The development of this instrument and its unique features are described, and its initial clinical use is summarized. This transnasal transsphenoidal speculum has interchangeable blades, unique blade angulations, and independent blade opening mechanisms and allows safe, optimal exposure in all patients regardless of the size and anatomical aberrations of individual nasal and endonasal regions. An attached endoscope carrier further allows it to be used interchangeably with microscopic or endoscopic techniques without having to remove the speculum; likewise, a single surgeon can use both hands without need of an assistant. A forehead headrest component adds further stabilization. This device has been used successfully in 90 transsphenoidal procedures.

Decompression for dysthyroid ophthalmopathy via the orbital rim approach

1994 ◽  
Vol 80 (3) ◽  
pp. 580-583 ◽  
Author(s):  
Kost Elisevich ◽  
Larry Allen ◽  
Uldis Bite ◽  
Robert Colcleugh
Keyword(s):  
Lateral Wall ◽  
Anterior Wall ◽  
Infraorbital Nerve ◽  
En Bloc ◽  
Orbital Cavity ◽  
Content Type ◽  
Eyelid Closure ◽  
Orbital Roof ◽  
Good Cosmetic ◽  
Orbital Rim

✓ A technique is described wherein the approach to the orbital cavity, with resection of its roof and lateral wall, is facilitated by a single burr hole and local en bloc removal of the lateral and supraorbital margins. A satisfactory decompression with reduction of proptosis of the orbital contents and a good cosmetic result is achieved without the need for a large dural exposure. The approach may be combined with removal of the anterior wall of the frontal sinus in cases where the lateral aspect extends appreciably laterally. Access to the orbital roof and lateral wall is straightforward and can be coupled with further removal of the floor lateral to the infraorbital nerve and medial wall. Advancement of the orbital rim upon bone replacement adds to orbital volume, creating better mechanical advantage for eyelid closure.

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